Schlosshauer B
Fortschr Med. 1975 Sep 11;93(25):1129-32.
During long-term intubation and tracheotomy in childhood there is risk of stenosis in 3 regions: 1. in the area of the cricoid (ring) cartilage, 2. in the area of the tracheostomy, 3. in the area of the inflated cuff of the tube. To prevent this it is recommended to take an endoscopic look at the mucous membranes when changing the intubation tube or the tracheal cannula; to use for long-term intubation the naso-tracheal approach, combined with a tube with the smallest possible diameter; to use the "open-type tracheotomy" with a mucous membrane-epidermis suture and without the removal of cartilage. Careful inflation of the cuff and rhythmical changing of the position of the cuff in the cervical segment of the trachea lower the risk of pressure-induced damage. If there is an infection or a metabolic disease the mucous membranes are extremely sensitive to pressure. Serious stenoses frequently make laryngical and tracheal plastic surgery in several sessions necessary. The curvature and stiffening of the ventral wall of the trachea can be achieved by implantation of arched cartilage from the cartilage bank.
儿童长期插管和气管切开时，有3个部位存在狭窄风险：1. 环状软骨区域；2. 气管造口区域；3. 气管导管气囊充气部位。为预防狭窄，建议在更换插管或气管套管时，对黏膜进行内镜检查；长期插管采用经鼻气管途径，并使用尽可能小直径的导管；采用“开放式气管切开术”，进行黏膜 - 表皮缝合，不切除软骨。小心给气囊充气，并使气囊在气管颈段的位置有节奏地改变，可降低压力性损伤风险。如果存在感染或代谢性疾病，黏膜对压力极为敏感。严重狭窄常常需要多次进行喉和气管整形手术。可通过植入软骨库的拱形软骨来实现气管前壁的弯曲和加固。
